الفهرس 
The MyocardiumOnly 14 pages are availabe for public view
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Abstract
C
ardiomyopathy is a disease that affects the cardiac muscle. It could be classified pathophysiologically into three main types. The hemodynamic, clinical aspects and management differ from one type to another. They include:
1- HCM.
2- DCM.
3- RCM.
Preoperative assessment should include the determination of the type of cardiac lesion, cardiac efficiency, the hemodynamic derangement and how it could be compensated as well as the presence of associated diseases.
The anesthetic plan for cardiomyopathic patients undergoing non-cardiac surgery should include specific and good monitoring of these patients which depends on the type of cardiac lesion, cardiac reserve and hemodynamic state of these patients. Invasive blood pressure measurement during surgery appears to be important. Also, it is very important to measure the filling pressures of the right side of the heart and cardiac output through a Swan-Ganz catheter to estimate the pulmonary artery pressure, pulmonary wedge pressure and cardiac output.
All of volatile anesthetic agents have a depressant effect on myocardial contractility so they can be replaced by narcotic analgesics such as fentanyl, sulfentanyl and alfentanyl to ensure preservation of myocardial contractility. Precautions should be taken if regional anesthesia is considered, such as HR, blood pressure, CO and right atrial filling pressure.
It is important to study the type of surgery and the possibility of using local techniques as well as the effect of spinal epidural block in cases of surgeries of the lower abdomen or lower limbs and the precautions to be taken if they are given e.g. monitoring of HR, systemic blood pressure, filling pressures of the right side and CO in severe cases. The postoperative hemodynamic monitoring should be continued until the patient becomes stable.
The follow up with blood gases is important as well, since, it could be affected as a result of postoperative pain or affection of the respiratory dynamics after anesthesia with narcotics as fentanyl, sulfentanyl or alfentanyl. Drugs such as inotropes, calcium channel blockers and beta-blockers should be continued after surgery according to the hemodynamic status. Congestive heart failure, cardiac dysrhythmia, hypotension, hypertension, nausea and vomiting and other expected complications must be treated carefully in the intensive care unit.